Pathways to Depression & Why Images are Necessary for Healing

In the following days I will write about Psychological factors that are pathways towards depression, as well as consequences of them. Finally I write why I believe that using only words in therapy is not sufficient for healing.

  1. Absence of adoration
  2. Misattunement
  3. Loss of Power
  4. Unresolved Grief
  5. Loss of community & faith
  6. Words are not enough: Healing through images

The Absence of Adoration

A baby is born, and there you have it – the expectation of love.  To be cherished, protected and adored. To be wanted. We all have that need, we know it. Take your own measure: How was it for you? I am talking here of up to the age of twelve, with every year up to that magical age, counting. A child who is loved and adored, who is protected and wanted – a child whose parents look at it with pleasure – receives a magical ingredient that protects against a variety of life-long problems. Being loved by parents is the primary vaccine that boosts mental health, providing a protective factor for life. A necessary, yet not sufficient condition, for it has to be combined with power & meaning.

The absence of it has the opposite effect – inner grief and loneliness seem to run in our veins. It is a longing that lies beyond words.

A note on siblings: Siblings can love you and hate you. That can be ok, depending on the balance. It can even be good for you, if the balance is on the side of love. If the balance is on the side of hate & resentment, the scales can begin to tip, often towards guilt, but not necessarily depression, except if it happens in the absence of parental protection. 


Lack of rapport between infant and parent or caregiver such that the infant’s efforts at communication and expression are not responded to in a way that allows the infant to feel understood.

Misattunement can happen under both conditions: love and the absence of it. Attunement means, of course, being in tune. A child squirming in a parent’s arms is, of course, a child wanting to be put down. This is clear, and being attuned (of course), means putting the child down and not holding the child even firmer. There are many variations on this theme. An infant turning its head away when having a face-to-face interaction, means that the infant needs a break, and does not need to be tickled on the cheeks to make its head turn back again. A simple pause to see what the baby does next, is all that is required. Following a child’s lead and interpreting their needs appropriately, is what it means. A toddler being frequently interrupted in its endeavours, a child being constantly interacted with or being ignored or distracted when it seeks interaction, that is misattunement.

The examples above have to do with physical attunement. Here are 2 components:

  1. Letting a child be when they are busy doing something that comes spontaneously. It is the opposite of interference. Too much interference is at the root of much ‘bad’ behaviours in a child. It is a source of great frustration. Some children rebel. Worse off are those who give up on exploration. Spontaneous exploration is the root of curiosity and it’s highly important off-shoot: Inner Motivation.
  2. Responding appropriately when a child expresses a physical need. A baby who cries is calling for a humane response, a child who lifts up its arms is asking to be picked up, a frightened toddler requires a calm intervention to restore equilibrium, an energetic child needs a physical outlet, etc. Not having basic needs such as these met, having them ignored, or even being punished for having such normal needs, results in an adult who is out of sync with their own needs as well as those of others. An adult who struggles to restore their own equilibrium.

We see this in depression as an inclination towards regression. As if the person is still seeking for someone to look after them. As if their unmet needs in childhood are still yearning to be fulfilled.

It is an interesting psychological (genetic?) expression, well-known to therapists, that if appropriate developmental/biological needs are not met, they keep on searching for fulfilment, and find expression in ‘abnormal’ ways. For example, a toddler whose need for exploration is consistently curtailed, either collapses (becomes passive and unmotivated) or rebels, becoming aggressive. An adolescent with no constructive outlets for an innate need for adventure & group belonging will find destructive ways to have these needs met. Denying and punishing your own body, whether through overuse, abuse or neglect is an over-reaction to not having had basic nurturance needs met or having had your body violated. A body, as much as a mind, requires positive interaction (which is why group sport is way more fun than gym).

Every stage of life has its own developmental needs.

After many decades, the psychosocial stages (he named them “crises) of Erik Erikson still have value. I have posted them below. Please read about them at

At every age, it is life-enhancing to notice what your ‘natural’ instincts are, and how you can be blocking their pathways.

The tricky matter of emotions: Attunement as “mind-mindedness”

Mind-mindedness is a concept in developmental psychology. It refers to a caregiver’s tendency to view their child as an individual with a mind, rather than merely an entity with needs that must be satisfied. Mind-mindedness involves adopting an intentional stance towards another person. Individual differences in mind-mindedness have been observed in the first year of life, and have been observed to have important developmental consequences.


Meaning making and emotion regulation

“Seeing ourselves from the outside and others from the inside”.

How do we make sense of our own feelings and the behaviours of others? How do we learn to soothe others and ourselves? Our understanding of an event and our capacity to deal with it are two sides of the same coin. Much personal distress and relational difficulties are the result of distorted meaning making.

Through the experiences that we had of being understood and being soothed in our earliest care-giving relationships, we learn to mentalize (to have in mind, to make meaning of) our own reactions as well as those of others. The ways in which we experienced this “having in mind”, will comfort us, or scare us, or make us anxious, or make us want to run away from it. How we respond today is very much imbedded in the early reactions of our caregivers.[1]

Authentic experiences of being are undermined when parents and partners lose sight of us, when we have to appease them or when we – or they – are idealised. It is the psychological essence of feeling lonely. Of feeling uncared for.

When a parent says to a baby, “Hey, I am sorry that I am irritated with you. It is not your fault. I am worried about work, and now I take it out on you; you are just a baby”, the baby gets to understand that feelings have reasons – even if they are sometimes unreasonable. The child learns that the emotional world, and its problems, has its own meanings, and that these can exist separately from the self. Combined with humour and compassion, powerful tools of distress management are thus being developed, as humans learn that people have separate minds and can use meaning making as tools to use when we need to cope with our own problems and the difficult behaviours of others.

Adults, who were not sufficiently kept in mind as children, can fail to keep others in mind as separate, meaningful beings. They do not check in with the other, but respond in terms of their own overwhelming feelings, and tend to negate the realities of the other.  In depressed persons, a history of the negation or oversight of their feelings (not necessarily with ill-intent), can lead to the cognition that ‘I do not really matter’, with a type of existential nihilism settling in. In an ironic reversal, they may tend to overvalue the feelings of others, whilst undervaluing their own.

This is not only a personal development; whole societies can act like this. Having your mind in my mind has as much to do with how we think of others, as about ourselves. It plays itself out when we meet people who are different from us, and wherever we find expressions of power. 

Having your mind in my mind

A little girl of six, two neat brown plaits standing away from her head is brought to my practice because of her bed-wetting. Her mother is having an affair. The parents are whispering behind their bedroom door, clearly in distress. When the little girl asks about this, they reply that she should not worry, this is a grown-up problem, and they will sort it out. The little girl continues to worry. I understand her bed-wetting to be her inability to cope with the tension that lives behind the closed bedroom door.

“Little girls worry when their parents argue behind closed doors, “ I say.

“Yes”, she replies. “But what does it mean? Does it mean murder?”

The capacity to see things from the child’s perspective is an essential ingredient of sensitive caregiving. This means that the child can be safely held in the parent’s mind. For a child to experience ‘thinking about’ as a safe and inherently useful experience, the parent has to sufficiently often name the child’s experience appropriately without criticism or judgment; just accepting and naming the child’s mind, as it is. Parents who react in ways that a child cannot make sense of, or cannot have in mind, or are unsuited to the child’s developmental stage, creates unknown anxiety and an avoidance to keep things in mind. In extreme cases, a state of “mindlessness” is created.

A few years ago I visited a woman who worked in our house when I was a child. I was curious about why I had felt so safe and free with her, and had cried such bitter tears when she left. We were having tea in her lounge, when her granddaughter, aged about six, and whom she looks after during the day, was called in from outside where she had been playing with others. She stood at the entrance to the door of the lounge, sulking. “What is the matter?” asked her grandmother, with a note of slight concern in her voice. Then promptly remarked, “Oh you are upset because you have to come in already.” The little girl’s posture relaxed (grandmother was right, and had read her mind correctly, and accepted this without fuss, and without blame or the need for a sermon). “Come”, said her grandmother in a soothing voice, “let me fetch you a yoghurt, and then I will tell you who this lady is who is having tea with us.” They left for the kitchen, hand in hand. When they returned the granddaughter joined us, sitting on the carpet, closer to me now, eating her yoghurt, curious about the stranger.

I understood that this woman has the wonderful ability to see a child, and to care about what she sees, and to name what she sees in such a manner that it contains the child, and to take ordinary practical steps to ‘make things better’.

The little girl in the first example, the one whose parents were experiencing problems, has parents who love her, and who care about her. But they did not feel safe to name her fears. Unnamed they lived inside her. She tried to make meaning by thinking of the worst thing she could think of – did they commit an act of murder? Would this mean they would have to go to jail? What would happen to her? Not coping, she wets her bed.

I have seen two extremes: Not talking about  and bizarre, sadistic manipulation.

The most extreme case of not talking about that I ever saw was of a 17 year old girl who had to have a mastectomy because of breast cancer, and nobody in the family was allowed to talk about it. Not even one conversation took place between mother and daughter. Unsurprisingly, the girl became mute and refused to leave her bedroom. This is extreme, I know. In my experience ‘ not talking about’ makes its appearance in some form or another in most (possibly all) families, but for sure it plays a substantial role in the lives of all persons with depression, and must be taken into consideration as part of a road to recovery.

Mind-mindedness is easiest understood as reflecting the other person’s experience back to them, and them agreeing that is how it is. In this way the person feels real and validated. Experiences of being understood grounds us, and has the world make sense. Having our feelings or our realities regularly denied, leads to mistrust and confusion – in ourselves and in the other.  I once saw a young woman who grew up with this double-bind: “Don’t be shy, say what you think”, she was admonished. The moment that she spoke up she was criticised, followed by “don’t be so sensitive.” What was she to think of herself and her opinions? How was she to make sense of her own mind and the minds of others?

Let met make clear that attunement does not have to happen 100% of the time. This is not necessary, at all. It is not even recommended. Too much attunement is intrusive. Normality is what we are striving for.  80- 70% Of the time would be great, 60% of the time would be fine. Less than that, and you will be picking up some trouble.

[1] There exists a vast field of research on the long-term influence of early caregiving experiences.  You can search “Attachment theory” and look for names like John Bowlby and Mary Ainsworth.

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